I have reviewed the above stated transaction/s and hereby file a dispute for reason/s hereunder: DUPLICATE BILLING ☐ I was charged twice for the same transaction. INCORRECT AMOUNT BILLED ☐ The amount charged to my account was incorrect, as actual amount is PHP______________. Enclosed is a copy of the proof of payment showing the correct transaction amount. PAID BY OTHER MEANS ☐ I paid for the transaction through other means. Enclosed is the document to prove other method of payment. (e.g. cash/cheque receipt, statement of account for a different credit card) CANCELLED TRANSACTION/SERVICE ☐ I have cancelled the transaction/recurring service with the merchant on__________________. Please see acknowledged cancellation letter. NON-RECEIPT OF GOODS/SERVICE ☐ I did not receive the goods/services from merchant last ___________________. I contacted the merchant regarding this on ___________________________. UNRECOGNIZED TRANSACTION I do not recognize the transaction and would like to request for a copy of the signed slip. I agree that a ☐ retrieval fee of PHP300.00 (per transaction slip) will be charged to my account in case the transaction is valid. UNAUTHORIZED TRANSACTION ☐ I did not authorize the transaction. I did not sign any slip nor received goods/services from the merchant. (Note: Card used in the disputed transaction will be blocked.) DEFECTIVE OR NOT AS DESCRIBED ☐ Goods/services received were either not as described, damaged/defective, or not suitable for its intended purpose. I have contacted the merchant to resolve the dispute on ___________________. CREDIT NOT PROCESSED ☐ I did not receive the credit/refund as promised by the merchant. Enclosed is a copy of the credit memo issued by the merchant. OTHERS – Please specify reason: ☐ _______________________________________________________________________________________

In filing this dispute, I hereby declare that:

☐ The credit card used for the disputed transaction/s has always been in my or in the supplementarycardholder’s possession. Enclosed is a photocopy of the front and back image of the card.☐ The credit card has been reported lost/stolen on _______________________.

Investigation of the disputed transaction/s may take up to 120 days. Please note that we will only be able to proceedwith the dispute process if the requirements are complete. Therefore, it is important that the required steps (e.g.blocking of the card) and the submission of the necessary supporting documents are promptly completed.Updated November 2016